Clinical- and imaging-based prediction of stroke risk after transient ischemic attack: the CIP model.
OBJECTIVE
Predictive instruments based on clinical features for early stroke risk after transient ischemic attack suffer from limited specificity. We sought to combine imaging and clinical features to improve predictions for 7-day stroke risk after transient ischemic attack.


METHODS
We studied 601 consecutive patients with transient ischemic attack who had MRI within 24 hours of symptom onset. A logistic regression model was developed using stroke within 7 days as the response criterion and diffusion-weighted imaging findings and dichotomized ABCD(2) score (ABCD(2) >/=4) as covariates.


RESULTS
Subsequent stroke occurred in 25 patients (5.2%). Dichotomized ABCD(2) score and acute infarct on diffusion-weighted imaging were each independent predictors of stroke risk. The 7-day risk was 0.0% with no predictor, 2.0% with ABCD(2) score >/=4 alone, 4.9% with acute infarct on diffusion-weighted imaging alone, and 14.9% with both predictors (an automated calculator is available at http://cip.martinos.org). Adding imaging increased the area under the receiver operating characteristic curve from 0.66 (95% CI, 0.57 to 0.76) using the ABCD(2) score to 0.81 (95% CI, 0.74 to 0.88; P=0.003). The sensitivity of 80% on the receiver operating characteristic curve corresponded to a specificity of 73% for the CIP model and 47% for the ABCD(2) score.


CONCLUSIONS
Combining acute imaging findings with clinical transient ischemic attack features causes a dramatic boost in the accuracy of predictions with clinical features alone for early risk of stroke after transient ischemic attack. If validated in relevant clinical settings, risk stratification by the CIP model may assist in early implementation of therapeutic measures and effective use of hospital resources.
Ay
Hakan
H
AA Martinos Center for Biomedical Imaging and Stroke Service, Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Room 2301, Charlestown MA 02129, USA. hay@partners.org
Arsava
E Murat
EM
Johnston
S Claiborne
SC
Vangel
Mark
M
Schwamm
Lee H
LH
Furie
Karen L
KL
Koroshetz
Walter J
WJ
Sorensen
A Gregory
AG
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D015897:Comorbidity; D003198:Computer Simulation; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D018450:Disease Progression; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*